Stepping Out

Mental illness has long carried a stigma of shame, something to be kept secret. Yet the more we learn about brain chemistry, the more we realize it's not a sign of character weakness but rather biological physiology.

In his US Surgeon General's report from December 1999, David Satcher, MD, PhD, stated, "Few families in the United States are untouched by mental illness." In any given year, an estimated one in five Americans experiences some sort of diagnosable mental disorder. At some time in our lives, half of us have suffered from a psychiatric condition. These statistics are indeed sobering—and, for anyone who's had an experience with mental illness, they are also comforting. You are not alone.

When dealing with mental illness, it's important to understand the roles of medication and a good doctor. While this article focuses on proactive measures for empowering oneself, there may be a time and place for pharmaceuticals. Many people who have been afflicted with mental illness have considered prescription drugs a saving grace, enabling them to function in society on a day-to-day basis.

There are also a variety of other therapies and lifestyle practices that can help alleviate mental illness, including nutrition, exercise, adequate rest and relaxation, a positive attitude and a rich support network. Nutrition has a great influence on brain chemistry as well. What you eat influences the health of nerve cells and levels of neurotransmitters, the nervous system's chemical messengers.

Mood Lifters to Beat Depression Nutrient deficiencies can cause low levels of serotonin, a neurotransmitter linked to mood, and many studies have found that depression is often associated with serotonin deficiency. Several natural remedies can boost levels of this important neurotransmitter, including exercise, 5-hydroxytryptophan (5-HTP), omega-3 essential fatty acids (EFAs) and B vitamins.

To produce serotonin, the body first converts the amino acid L-tryptophan to 5-HTP. "Although tryptophan is a component of most protein-rich foods, dietary manipulation isn't a practical way to increase brain levels of tryptophan," says Timothy C. Birdsall, ND, director of naturopathic medicine at the Midwestern Regional Medical Center in Zion, Ill. He explains, "As little as 1 percent of dietary L-tryptophan may be transported into the central nervous system." However, in people with a personal or family history of depression, a diet devoid of tryptophan can cause moods to crash in a matter of hours (Biology of Psychiatry, 2000, vol. 4). Unfortunately, in 1989 contaminated tryptophan was linked with a serious disorder called eosinophilia-myalgia syndrome (EMS), causing this supplement to be removed from the US market.

However, 5-HTP, a conversion one step closer to serotonin, is available. And, according to Birdsall, 5-HTP easily crosses into the brain. Fifteen human studies have shown that, in people with depression and bipolar disorder, 5-HTP performs significantly better than placebo and as well as the antidepressants fluoxetine (Luvox) and imipramine (Norfranil), but with fewer side effects. Furthermore, symptom relief begins within three to 14 days—much faster than the four to six weeks needed for most prescription antidepressants (Alternative Medicine Review, 1998, vol. 3).

According to Michael A. Schmidt, PhD, author of Smart Fats (North Atlantic Books), our culture consumes too much saturated fat and omega-6 essential fatty acids (EFAs), thanks to the corn and soybean oils used in so many processed foods. We do not get enough of the omega-3 EFAs found in cold-water fish (mackerel, cod, herring, salmon and anchovy), green leafy vegetables, pumpkin seeds, Brazil nuts, walnuts, flaxseed oil and hemp seed oil. These omega-3s play a role in healthy brain cell and neurotransmitter function, especially the omega-3s from fish, docosapentaenoic acid (DHA) and eicosapentaenoic acid (EPA). It's not surprising then that depressed people often show low levels of omega-3s in their diets and cell membranes (Journal of Affective Disorders, 1998, vol. 48). One study found that taking 9.6 grams daily of omega-3 fatty acids for four months benefited people with bipolar disorder significantly more than placebo (Archives of General Psychiatry, 1999, vol. 56).

In addition to EFAs, several B vitamins are needed to maintain the nerve systems involved in mood regulation. It's estimated that one-third of adults with depression are deficient in folic acid, the vitamin most closely linked to depression and bipolar disorder. Furthermore, people with low folic acid levels who added dietary supplements to their menu to make up for the deficit responded better to antidepressants, including Prozac and lithium carbonate, a drug used to treat bipolar disorder (Journal of Affective Disorder, 2000, vol. 60; 1986, vol. 10).

Both folic acid and vitamin B12 are needed to convert amino acids to S-adenosylmethionine (SAMe), which is a necessary element to produce serotonin and other neurotransmitters. Because some studies show that it has a fast-acting antidepressant effect (Drugs, 1994, vol. 48), producing results within four days, SAMe is often used to hasten the onset of action of imipramine (Psychiatry Research, 1992, vol. 44).

Herbs can also provide freedom from depression."Dozens of studies have demonstrated St. John's wort's (Hypericum perforatum) remarkable ability to alleviate mild to moderate depression," says Hyla Cass, MD, assistant clinical professor of psychiatry at UCLA School of Medicine and author of St. John's Wort: Nature's Blues Buster (Avery Publishing Group). Several studies show that this roadside herb is as effective as Prozac, Zoloft and tricyclic antidepressants and with fewer side effects (British Medical Journal, 1996, vol. 313).

Ginkgo (Ginkgo biloba), though better known as a treatment for dementia, has been shown in many studies of older people to lighten mood and lift depression (Fortschritte der Medizin, 1990, vol. 108). Scott Shannon, MD, integrative psychiatrist and president-elect of the American Holistic Medical Association (AHMA), finds this herb, in combination with St. John's wort, helpful to depressed patients with prominent symptoms, including low energy, apathy and fatigue.

Create Calm to Oust Anxiety Poor dietary habits can trigger or aggravate anxiety. For example, eating a meal high in simple carbohydrates can cause blood sugar levels to soar, then plummet. Missing a meal also leads to low blood sugar. And when sugar levels drop, epinephrine (adrenaline) rises. The result is lightheadedness, difficulty concentrating, irritability and jitteriness. Too much caffeine can also cause jitters, and for some, downright anxiety.

These symptoms call for a diet centered on whole grains, vegetables, fruits, fish, poultry and meat. For people vulnerable to attacks of low blood sugar, small, frequent meals can help. Shannon asks his anxious patients to quit caffeine, including coffee, black tea and sodas.

Inositol, a B-vitamin relative, affects nerve transmission, including nerves that use serotonin as a neurotransmitter. A trial in which subjects were given 18 grams a day of inositol showed significantly decreased symptoms of obsessive-compulsive disorder (American Journal of Psychiatry, 1996, vol. 153). The same researchers tried giving 12­18 grams a day of inositol to patients with a variety of psychological disorders and found it effective in depression, panic attacks and obsessive-compulsive disorder, all conditions that respond to selective serotonin reuptake inhibitors (European Neuropsychopharmacology, 1997, vol. 5).

Kava (Piper methysticum) is traditionally used in the South Pacific as a ceremonial and tranquilizing beverage. Harold H. Bloomfield, MD, author of Healing Anxiety Naturally (Harper Perennial), much prefers kava over benzodiazepines, the category of tranquilizers that include Valium, Serax and Xanax. "Whereas benzodiazepines can be addictive, impair memory and worsen depression, kava improves mental functioning and mood and is not addictive," he says. Studies show it lowers anxiety better than placebo, with improvements beginning within one week (Pharmacopsychiatry, 1997, vol. 30).

Valerian (Valeriana officinalis), while best known as an insomnia buster, also soothes emotional stress. Bloomfield says this herb "has a musty, old-gym-socks aroma, but its sedative effect is nothing to wrinkle your nose at." One study found that it relieved performance anxiety and other social stresses (Pharmacopsychiatry, 1988, vol. 21).

Other calming supplements include 5-HTP because, as with depression, it regulates serotonin levels. Pacifying herbs include passionflower, California poppy, hops, skullcap and chamomile. Researchers have also reported anxiety relief using an Ayurvedic blend called Worry Free.

A final thought: For people with mild complaints, these simple remedies may be enough to restore health. But mental illness requires a proper psychiatric evaluation and treatment. While lifestyle changes, proper nutrition and herbs can facilitate mental wellness, sometimes prescription drugs are literally life-saving and may be necessary throughout a person's life.

Everyone has the right to peace of mind—whether it's found in meditation, medication or a cup of tea.

Linda B. White, MD, is the co-author of Kids, Herbs, and Health (Interweave Press) and The Herbal Drugstore (Rodale).